valvular heart - aortic stenosis

Question 1

what is aortic stenosis?

Answer 1

narrowing of the aortic valve in the heart

this restricts blood flow through the valve and therefore decreasing Cardiac Output

the heart then needs to squeeze (contract) harder to pump blood from the left ventricle into the aorta.

Question 2

what are the causes?

Answer 2

Rheumatic Heart Disease

Congenital Bicuspid Valve (most common cause in <65y/o)

Degeneration (calcification)

Calcification is the most common cause in > 65y/o

Question 3

what are the 4 symptoms?

Answer 3

Exertional Chest pain
Exertional Breathlessness
Exertional Syncope/Pre-syncope (late sign)
Heart failure

Question 4

what 5 examinations are carried out?

Answer 4

Carotid Pulse – small volume and slowly rising

Apex Beat - Vigorous and sustained (non-displaced)

Auscultation: Ejection Systolic Murmur radiating to Carotids. Normal S1, S2: less audible A2 (reduced intensity of second heart sound)

Right Ventricular Heave

JVP – prominent (if Right Heart failure is present)

Question 5

what 5 investigations are used?

Answer 5

ECG

Echocardiography

CXR

Cardiac Catheterisation

CMR

Question 6

what is the treatment used?

Answer 6

Aortic Valve replacement or repair (if symptomatic; but the otherwise cut off gradient is 40mmHg)

(balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for aortic valve replacement)

(If asymptomatic then observe the patient)